FACE

Acute Apical Abscess

A collection of purulent exudate at the apex of a nonvital tooth accompanied by pain and fever with potential discharge into the mouth; usually there is no periapical radiolucency; the condition requires pulp extirpation or tooth extraction, incision and drainage, and antibiotic therapy.

Acute Inflammatory Lesions

A group of conditions in which acute inflammation predominates. They are usually accompanied by pain, swelling, and pus production. Establishment of drainage and appropriate antimicrobial therapy will cure acute inflammatory conditions.

Benign Mucous Membrane Pemphigoid

An uncommon autoimmune condition that affects only the oral mucous membrane and eyes; it manifests as bullae and ulcers, has a distinctive histology, and runs a benign course; improvement usually occurs with anti-inflammatory medication; unlike pemphigus, it is not fatal. Aetiology: Autoimmune Location(s): Oral mucosa Clinical Features: Presence of gingival bullae that soon rupture leaving a slough covering a shallow ulcer; may also affect the eyes. Radiographic Features: None Microscopic Features: "Subepithelial clefting" is characteristic. Complications: Eye involvement may lead to blindness Treatment: Corticosteroid therapy Prognosis: Good with appropriate therapy Pathogenesis: Production of auto antibodies directed against the basement membrane of oral mucosa.

Haemangioma

A common benign neoplasm arising from blood vessels manifesting as flat or raised red-purple surface discoloration; cosmetic requirements may warrant attempted removal of a haemangioma.

Aetiology: DevelopmentalLocation(s): Anywhere on mucous membrane or within boneClinical Features: Flat or raised red lesion that may blanch under pressureRadiographic Features: If within bone, appears as ill-defined radiolucencyMicroscopic Features: Blood vessels filled with RBC'sComplications: haemorrhageTreatment: Surgical excision (small); produce scarring with chemicals or lasersPrognosis: GoodPathogenesis: Unknown; many seem to be inherited

Aetiology: DevelopmentalLocation(s): Anywhere on mucous membrane; tongue, cheek most common sitesClinical Features: Raised, diffuse, bubbly, or shaggy lesions of the same colour or lighter than surrounding mucosaRadiographic Features: NoneMicroscopic Features: Many lymphatic vessels filled with lymphComplications: May be difficult to remove entirely; tend to recurTreatment: Surgical excision or produce scarring with chemicals or lasersPrognosis: GoodPathogenesis: Unknown

Nasolabial Cyst

A rare true soft tissue cyst appearing as a facial swelling of the upper lip and the side of the nose; surgical removal will cure this cyst.

Aetiology: Entrapped embryonic epithelium in the developmental fissures between lateral nasal and maxillary processesLocation(s): Upper lip and side of noseClinical Features: Asymptomatic swelling of upper lip and side of noseRadiographic Features: None; can be visualized with injection of radiopaque dyeMicroscopic Features: A true epithelial-lined soft tissue cystComplications: NoneTreatment: Surgical removalPrognosis: Does not recur with complete removalPathogenesis: Stimulation of entrapped epithelium

Neurofibroma

An uncommon benign neoplasm arising from nerve sheath cells manifesting as single or multiple submucosal nodules; it has a characteristic histology; the multiple forms causes disfigurement and may lead to malignant change; surgical excision will cure single neurofibromas.

Aetiology: Developmental

Location(s): Any submucosal or subcutaneous site; may occur within bone too.Clinical Features: Single or multiple submucosal nodules covered with normal mucosa or skin; sometimes covering skin has "cafe-au-lait"spots.Radiographic Features: None; rare central bone lesions will produce radiolucency.Microscopic Features: Not encapsulated; cellular fibrous appearance reminiscent of nerves.Complications: May recur; multiple forms are disfiguring and may become malignant.Treatment: Surgical excision for single lesions; treatment not successful for multiple.Prognosis: Single lesions good; multiple form poor.Pathogenesis: Unknown for single form; multiple form is inherited.

Primary Herpetic Gingivostomatitis

An acute initial infection with the Herpes simplex virus manifesting with fever, malaise, lymphadenopathy, and vesicles followed by ulcers; no current treatment will rid the patient of HSVI; most HSVI+ patients do not remember or did not experience primary herpetic gingivostomatitis.

JAW

Acute Apical Abscess

A collection of purulent exudate at the apex of a nonvital tooth accompanied by pain and fever with potential discharge into the mouth; usually there is no periapical radiolucency; the condition requires pulp extirpation or tooth extraction, incision and drainage, and antibiotic therapy.

Adenomatoid Odontogenic Tumour

A rare harmless benign jaw neoplasm of odontogenic epithelium occurring in children and appearing as a unilocular radiolucency around the crown of an unerupted tooth; surgical excision will cure this neoplasm.

Aetiology: Odontogenic epitheliumLocation(s): Anterior maxilla is the most common site.Clinical Features: May be no clinical features; however, may prevent tooth eruption.Radiographic Features: Radiolucency around the crown of an unerupted tooth; may be small radiopacities.Microscopic Features: Well-differentiated epithelial" duct-like" structures; encapsulated.Complications: None.Treatment: Surgical excision.Prognosis: Will not recur with complete excision.Pathogenesis: Presumed activation of enamel organ epithelium.

Ameloblastic Fibroma

An uncommon benign jaw neoplasm of odontogenic epithelium and c.t. occurring in children and appearing as a unilocular radiolucency in tooth-bearing areas; since it does not infiltrate, surgical excision will cure this neoplasm.

Aetiology: Odontogenic epithelium

Location(s): Posterior mandible is the most common location.

Clinical Features: Large lesions may cause jaw expansion;otherwise, usually there are no clinical features.

Ameloblastoma

An uncommon benign jaw neoplasm of odontogenic epithelium appearing as a unilocular or multilocular radiolucency; because of its locally-infiltrative growth pattern, this neoplasm may be difficult to eradicate.

Aetiology: Odontogenic epithelium

Location(s): Posterior mandible is the most common location.

Clinical Features: Large lesions may cause jaw expansion; otherwise, usually there are no clinical features.

Radiographic Features: Multilocular radiolucency; small lesions can be unilocular.

Pathogenesis: Presumed activation of odontogenic epithelium in rests, in cyst linings, or in the developing enamel organ

Apical Cyst

A common situation in which epithelial cells within chronic apical periodontitis are stimulated to proliferate with formation of a central cavity; removal of cause and surgical removal will cure this lesion.

Chronic Apical Periodontitis

A common condition usually without severe signs or symptoms recognized by a well-defined radiolucency at the apex of a non-vital tooth; its treatment requires endodontics therapy or tooth extraction.Aetiology: Non-vital tooth

Location(s): Either jaw; apex of a non-vital tooth.

Clinical Features: Usually none

Radiographic Features: Periapical radiolucency

Microscopic Features: Granulation tissue and chronic inflammation

Complications: May recur if antigen source is not eliminated.Treatment: Will not recur with proper therapy

Dentigerous Cyst

A common true epithelial-lined jaw cyst appearing as a radiolucency surrounding the crown of an unerupted or impacted tooth; rarely ameloblastoma will arise in this cyst; surgical excision will cure a dentigerous cyst.Aetiology: Odontogenic epithelium

Location(s): Either jaw.Clinical Features: None; may be jaw expansion with large lesions

Treatment: Surgical reduction of jaw expansion; may continue to grow for a time.

Prognosis: Growth slows or stops in adulthood.

Pathogenesis: Developmental proliferation of fibrous c.t. and bone

Globulomaxillary Cyst

An uncommon true jaw cyst appearing as a radiolucency between the roots of vital maxillary lateral incisor and cuspid (canine) teeth; surgical removal will cure this cyst; some dispute the origin of this lesion.Aetiology: Entrapped epithelium

Jaw Lesions

within the jaws are detected as radiolucencies, radiopacities, or mixed radiolucent/opacities on radiographic examination.Aetiology: Non-vital tooth or infection; otherwise unknownLocation(s): Mandible or maxillaClinical Features: Usually none; large lesions may cause noticable jaw expansion

Prognosis: Does not recur with complete removalPathogenesis: Stimulation of enclaved epithelium

Metastatic Jaw MalignanciesUncommon appearance of unexplained jaw radiolucency that proves, on biopsy, to be composed of malignant cells which are not of oral origin; primary malignancies are often in breast, prostate, kidney, or thyroid; prognosis is grave.

Pathogenesis: Development of metastatic colony from primary malignancy in extra-oral site.

Odontogenic Keratocyst

A jaw cyst of dentigerous or primordial origin lined with keratinized epithelium appearing as a radiolucency around the crown of an unerupted tooth (dentigerous) or in a tooth-bearing area unassociated with a tooth (primordial); this cyst may be difficult to remove surgically and therefore may recur.

Aetiology: Odontogenic epitheliumLocation(s): Either jaw

Clinical Features: None; may be jaw expansion with large lesions

Radiographic Features: Radiolucency associated or unassociated with a tooth.

Microscopic Features: True epithelial-lined cyst lined by keratinizing epitheliumComplications: May be difficult to remove; they may recur.Treatment: Surgical removalPrognosis: Does not recur with complete removalPathogenesis: Stimulation of odontogenic epithelium.

Odontoma

A relatively common benign odontogenic neoplasm producing all dental tissues and appearing as a well-demarcated mostly radiopaque lesion in tooth-bearing areas; surgical excision will cure this lesion.Aetiology: Odontogenic epithelium

Location(s): Either jaw; maxilla a more common site.Clinical Features: Usually none; may prevent tooth eruption.

Radiographic Features: Multiple small radiopacities some of which may resemble "small teeth."Microscopic Features: Collections of all hard and soft dental tissues.

Complications: None.Treatment: Surgical excision

Prognosis: Complete excision will cure this lesion.

Pathogenesis: Presumed activation of developing dental tissues

Osseous Dysplasia

A benign, self-limiting fibrosseous condition that is a possible reaction to local injury appearing as radiolucent and radiopaque lesions at the apices of vital teeth; once correctly identified, no therapy is necessary.

Pathogenesis: Extension of infection into jaw; patient may be immunocompromised or immunosuppressed.

Osteosarcoma

An uncommon malignant neoplasm of osteoblasts appearing as a poorly demarcated radiopacity/radiolucency; it metastasizes early by blood; radical surgery is required; it has a poor prognosis.Aetiology: Unknown

Location(s): Either jaw; mandible more common.

Clinical Features: Jaw swelling with large lesions; often associated with "bone pain."